Alcoholism may be twice as fatal for women as for men, according to a new study from Germany.

The women with alcohol addiction were five times more likely to die during the 14-year period of the study than women in the general population were. Among men with alcohol addiction, the death rate was about double that of men in the general population.

Additionally, alcoholics in the study who underwent specialized medical treatments or detoxification programs were no more likely to survive than those who did not seek intervention.

"The treatment system is not really suited yet to increase survival time," said study author Ulrich John, an epidemiologist at the University of Greifswald Medical School.

Most previous studies of alcoholics' mortality rates focused on alcoholics already in treatment, but the new study started with a general population of 4,070 people in northern Germany.

Researchers interviewed the study participants and asked about alcohol use. Based on their answers, and the criteria for alcoholism given in the Diagnostic and Statistical Manual of Mental Disorders, 153 were defined as alcoholics. Fourteen years later, the researchers followed up with 149 of the alcoholics.

Nearly a fifth of the alcoholics had died over the 14 years: seven of the 30 women, and 21 of the 119 men. For the women, this translated to an annual death rate of 1.67 percent; among women in the general population, the annual death rate was 0.36 percent. For the alcoholic men, the annual death rate was 1.26 percent, while the annual death rate for men in the general population was 0.66 percent.

Women tend to develop more of the health risks associated with alcoholism, but the reasons for this are not clear, John said. "Females, in a more short time span, develop diseases such as liver cirrhosis," he said.

Treatment & detox

Among the alcoholics, 34 had used treatments provided by the German government aimed at helping patients remain alcohol-free over the long term, such as addiction counseling and group therapy. Ten others had enrolled in detoxification programs, in which people quit drinking "cold turkey" and remained in treatment as long as their withdrawal symptoms occur.

Death rates among the alcoholics who had sought specialized treatments were the same as those alcoholics not in treatment, the researchers found. Those who entered detoxification programs had a higher death rate than alcoholics who did not seek detox.

Most likely to die were those with severe alcoholism, those with alcohol-related health problems such as liver disease, and those who rated their own health as poor.

However, the findings don't mean that treatments do not improve the survival of alcoholics, John said. People who "suffer from lots of diseases from their alcohol abuse — many more of them are getting into detoxification treatments," which could explain why those in detox programs had a higher mortality rate, he said.

Approximately 11 percent of alcoholics, typically the sickest ones, seek help in treatment or detoxification programs, said Susan Foster, director of policy research and analysis at the National Center on Addiction and Substance Abuse at Columbia University.

"Those with advanced disease are usually the ones who cycle in and out of detox programs or end up in treatment programs, many of which do not provide evidence-based care," Foster said.

Further, Foster said, addiction is disease that can include a range of substances. "Treatment must address all manifestations of the disease — only providing treatment for addiction involving alcohol will, by definition, limit the efficacy of treatment results."

So what can be done?

Preventing alcoholism could lower mortality rates, said Jürgen Rehm, director of social and epidemiological research at the Centre for Addiction and Mental Health in Toronto.

Training family doctors to test for alcoholism and related problems might be the best solution, Rehm said.

John said his future research will focus on computer-based screening tests for alcoholism problems, and subsequent counseling, in an effort to reach the entire population.

The study will be published in the January issue of the journal Alcoholism: Clinical & Experimental Research.

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